Research On The Operation Risk And Supervision Of "Chenghuibao"

At present,China has established a multi-level medical security system with social basic medical insurance as the main body,but the burden of individual and family medical expenses is still heavy,and the strength of medical security needs to be further strengthened.With low premium,wide threshold and high security as the main characteristics,"chenghuibao" has developed rapidly all over the country since 2020 with the support of national policies.As an inclusive and commercial health insurance product mainly aimed at protecting the risk of high medical expenses,it is provided by government departments in cooperation with insurance companies,It fills the gap between basic medical insurance and commercial health insurance and plays an important supplementary role in China’s multi-level medical security system.However,at present,in the rapid development trend of "chenghuibao",some problems and even chaos begin to appear,such as lower quotation than cost,multiple insurance in one city,false publicity,fraudulent use of the name of the government,low insurance participation rate in some cities,inconvenient claim settlement,etc.,which will lead to a series of operational risks.How to prevent these risks and promote the sustainable and healthy development of "chenghuibao" business is an urgent problem to be solved.Using the methods of normative analysis,comparative analysis,case analysis and induction,this paper comprehensively analyzes the operation risks of"chenghuibao" from the realistic background,development process and product characteristics of "chenghuibao",and deeply analyzes the causes of the risks,such as the lack of unified norms of local government behavior,unclear relevant rules,insurance companies lack basic medical and health data,insurance companies pursue short-term interests too much.It is pointed out that if these risks are not resolved in time,it will have a significant adverse impact on the sustainable operation of"chenghuibao" products and government credit.After theoretical analysis,induction and comparative research,according to the logic of raising problems,analyzing problems and solving problems,this paper finally puts forward policy suggestions to strengthen the supervision of "chenghuibao".Specific suggestions include optimizing top-level design and strengthening system guidance at the national level,such as standardizing the participation of local governments,establishing a medical insurance data sharing mechanism,promoting the purchase of individual account balance of medical insurance,and promoting the family joint insurance model;At the same time,we should strengthen the compliance supervision of the industry by the China Banking and Insurance Regulatory Commission and make up for the shortcomings of supervision.For example,we should create a fair business environment for"chenghuibao",strengthen the supervision of "one city,one policy",guide insurance companies to make accurate pricing,require insurance companies to settle claims"one-stop" handling,and strengthen the investigation and punishment of illegal acts of consumers and the protection of consumers’ personal information,Then promote the healthy and sustainable development of "chenghuibao".